Effectiveness of HBV Vaccination in Celiac Disease: A Cross-sectional Study

Abstract

Background: Celiac disease (CD) is an immune-mediated condition. Children with CD typically achieve lower hepatitis B vaccine-induced anti-HBs antibody levels compared to healthy children. Objectives: The purpose of this study was to compare the responses to the hepatitis B virus (HBV) vaccine in children with CD with those in healthy children. In addition, we examined the relationship between the patients’ responses to the hepatitis B vaccine and possible risk factors. Methods: This is a cross-sectional study with matched groups conducted at the Celiac Clinic of Shiraz, Iran, from February 2022 to May 2023. All study participants were ≤ 18 years of age and had received all doses of the standard hepatitis B vaccine at least 6 months before the study. The CD was diagnosed based on positive serology confirmed by duodenal biopsy demonstrating villous atrophy. Healthy controls were selected from individuals who attended routine clinic visits. Results: A total of 130 subjects participated (40.8% male), comprising 65 children with CD and 65 healthy children. Sixty-eight participants (52.3%) had protective titers of anti-HBs antibody [≥ 10 milli-international units per milliliter (mIU/mL)]. Of the participants with CD, 51 (78.5%) reported compliance with a gluten-free diet. The types of CD were typically distributed: 20 (30.8%) with typical CD and 45 (69.2%) with atypical CD. There was no statistically significant difference between the CD group and healthy children in levels of anti-HBs (P = 0.160). Within the CD group, atypical CD showed a significant association with reduced vaccine effectiveness [odds ration (OR) = 0.213, 95% CI: 0.054 - 0.843, P = 0.025]. Conclusions: There was no significant difference between the CD group and healthy children in the levels of anti-HBs. However, there was a significant association between atypical CD and reduced vaccine effectiveness, though this should be interpreted cautiously due to the limited sample size.